Monday, September 05, 2011

Woo promoting article in The Atlantic

This is an article about the growth of quackademic medicine in our teaching institutions and it's celebratory more than critical. It profiles the integrative medicine clinic of Dr. Brian Berman. That's right, this Dr. Berman. I blogged about him four years ago and it seems his clinic at the University of Maryland is still going strong. Stronger, apparently.

The article, like integrative medicine itself, is a mixture of quackery and general distortion with a little science and pseudo skepticism thrown in. A central premise is that no matter how nutty the idea, you can't call it quackery if it carries the imprimatur of a respected academic institution:

Concerns of outright malpractice or naked hucksterism seem grossly misplaced when applied to a clinic like Berman’s.

Below are a few more of the distortions contained in the article:

The false dichotomy between the conventional medicine approach and “healing.”

The claim that conventional medicine ignores prevention.

The notion that the principles of conventional medical science are obsolete because they originated in the era when acute infectious diseases were the leading killers.

The idea that medical science has failed to make significant advances in the care of chronic diseases. (Tom Sullivan debunks that popular canard here).

By and large the purported benefits of integrative medicine, as illustrated by the numerous testimonials in the article, are the result of the placebo effect and the generous time and personal attention lavished on the patients who attend. So, some might ask, what's the problem? Aren't those reasons enough to justify integrative medicine?

Not when those benefits are attributed to a quacky intervention. It's just unethical. As Steve Novella, interviewed for the piece, said:

Novella is a highly respected Yale neurologist, and the editor of Science-Based Medicine, an influential blog that has tirelessly gone after alternative medicine. I met with him in his home outside New Haven, Connecticut, where he argued that claims about the practitioner-patient relationship are only intended to draw attention away from the fact that randomized trials have by and large failed to show that alternative treatments work better than placebos. And while he concedes that sham treatments can give patients a more positive attitude, which can confer real health benefits, he is adamant that providing sham treatments at all—essentially fooling patients into believing they’re being helped—is highly unethical. “Alternative practitioners have a big advantage,” says Novella. “They can lie to patients. I can’t.”

Aside from the ethical considerations cited by Novella the argument raises another false dichotomy: that spending lots of time with patients and approaching them as whole persons is somehow uniquely inherent to integrative medicine and foreign to conventional medicine. For many counter-examples to that argument just read DB's many posts on the true nature of mainstream internal medicine or my post here where I cite the example of the late Thomas Brittingham as the exemplar.

No, it's not the pure notion of the whole person or spending time with patients that's unique to integrative medicine. So what is integrative medicine's uniqueness? I would submit that, in part, it's the fact that it makes quacky claims that are so appealing and sensational to the uncritical public that patients are willing to pay handsomely for it out of pocket. That eliminates some of the time pressure that exists under the reimbursement system for conventional medicine.

The article additionally points out the alarming degree to which quackademics are infiltrating the renowned Mayo Clinic, to a greater degree than even I was aware. Even the dean of the medical school is on board.

Some of the Mayo doctors quoted in the article are in favor of integrative medicine but their arguments are mainly sophistry. Though superficially appealing the defects and half-truths in their statements become apparent once a little critical thought is applied.

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About Me

Originally a traditional internist, I became a hospitalist in the early days of the “movement.” I'll be writing about clinical topics, mainly in hospital medicine. Occasionally politics and other stuff creep in. This content does not constitute medical advice (consult your physician) nor is it authoritative (check primary sources).